Girls Place, Inc. Employment Application

An Equal Opportunity Employer. Please fill out the following employment application as thoroughly as possible. Only the sections with a red asterisk are required for submission, however it would give us the most complete picture of yourself as a potential applicant if you fill out every section possible. Thank You for your interest in employment with Girls Place, Inc.

Contact Information
Name * First Last
Position(s) Applied For: *
Referral Source: * Advertisement Employee Relative Government Employment Agency Walk-In Private Employment Agency Other
Other / Name of Source (if Applicable)
Telephone Number * - (###) - ### ####
Email Address - Must be checked regularly. *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Contact / Background Information
If necessary, the best time to call you at home is... *
May we contact you at work? * Yes No
If yes, work number - (###) - ### ####
and best time to call at work
If you are under 18, can you furnish a work permit? * Yes No
Have you filed an application here before? * Yes No
If yes, give date filed:
Have you been employed here before? * Yes No
If yes, give dates:
Are you legally eligible for employment in this country? (Proof of U.S. Citizenship will be required upon employment.) * Yes No
Are you legally eligible for employment in this country? * Yes No
Date and time available to begin work: * / MM / DD YYYY
* : HH MM AM/PM
Type of Employment desired: * Full-Time Part-Time Temporary Seasonal Educational Co-Op
Are you on lay-off and subject to recall? * Yes No
Will you relocate if job requires it? * Yes No
Will you travel if job requires it? * Yes No
Are you able to meet the attendance requirements of this position? * Yes No
Will you work overtime if required? * Yes No
Have you ever been bonded? * Yes No
Have you ever worked at a job where your employer had insurance to protect his clients from any damage you may cause (intentially or accidentally)?
Have you been convicted of a felony in the last seven (7) years? * Yes No
Such conviction may be relevant if job related, but does not bar you from employment.
If yes, please explain:
Driver's License number (if job related):
State license held in:
Employment History

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below.
1
Employer:
Job Title:
Telephone: - (###) - ### ####
Dates Employed

From: / MM / DD YYYY
To: / MM / DD YYYY
Hourly Rate / Starting Salary $ . Dollars Cents
Hourly Rate / Salary Final $ . Dollars Cents
Summarize the nature of the work performed and job responsibilities:
Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Immediate Supervisor's Name & Title:
Reason for Leaving:
May we contact for reference? Yes No Later
2
Employer:
Job Title:
Telephone: - (###) - ### ####
Dates Employed

From: / MM / DD YYYY
To: / MM / DD YYYY
Hourly Rate / Starting Salary $ . Dollars Cents
Hourly Rate / Salary Final $ . Dollars Cents
Summarize the nature of the work performed and job responsibilities:
Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Immediate Supervisor's Name & Title:
Reason for Leaving:
May we contact for reference? Yes No Later
3
Employer:
Job Title:
Telephone: - (###) - ### ####
Dates Employed

From: / MM / DD YYYY
To: / MM / DD YYYY
Hourly Rate / Starting Salary $ . Dollars Cents
Hourly Rate / Salary Final $ . Dollars Cents
Summarize the nature of the work performed and job responsibilities:
Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Immediate Supervisor's Name & Title:
Reason for Leaving:
May we contact for reference? Yes No Later
4
Employer:
Job Title:
Telephone: - (###) - ### ####
Dates Employed

From: / MM / DD YYYY
To: / MM / DD YYYY
Hourly Rate / Starting Salary $ . Dollars Cents
Hourly Rate / Salary Final $ . Dollars Cents
Summarize the nature of the work performed and job responsibilities:
Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Immediate Supervisor's Name & Title:
Reason for Leaving:
May we contact for reference? Yes No Later
Comments (including explanation of any gaps in employment):
Educational Background (if job related)

A. List last three (3) schools attended, starting with last one. B. List number of years completed. C. Indicated degree or diploma earned, if any. D. Grade Point Average or Class Rank and E. Major and minor field of study (if applicable).
School 1
School
Number of Years Completed
Degree / Diploma
Grade Point Average or Class Rank
Major
Minor
School 2
School
Number of Years Completed
Degree / Diploma
Grade Point Average or Class Rank
Major
Minor
School 3
School
Number of Years Completed
Degree / Diploma
Grade Point Average or Class Rank
Major
Minor
List any foreign language(s) you know and check the boxes that describe your skill level.
Language
Check all that apply: Speak Some Speak Fluently Read Write
Language
Check all that apply: Speak Some Speak Fluently Read Write
Language
Check all that apply: Speak Some Speak Fluently Read Write
Language
Check all that apply: Speak Some Speak Fluently Read Write
References

List name and telephone number of three business/work references who are not related to you and are not previous supervisor. If not applicable, list three school or personal references who are not related to you.
Reference 1
Name *
Telephone * - (###) - ### ####
Years Known *
Reference 2
Name *
Telephone * - (###) - ### ####
Years Known *
Reference 3
Name *
Telephone * - (###) - ### ####
Years Known *
List professional, trade, business, or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)
Organization
Office(s) Held
Organization
Office(s) Held
Organization
Office(s) Held
Skills and Qualifications: Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company. *
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)
List any additional information you would like us to consider:
Please attach your Resume here. Only Word '.doc' or Adobe '.pdf' files will be accepted.
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary. By typing my name below, I hereby agree to abide by the rules and regulations of Girls Place, Inc., as they relate to my possible employment and understand that this will serve as my digital signature for this application: *

Girls Place, Inc. Employment Application

Girls Place, Inc. Employment Application

Contact Information

Contact / Background Information

Employment HistoryList your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below.

1

2

3

4

Educational Background (if job related)A. List last three (3) schools attended, starting with last one. B. List number of years completed. C. Indicated degree or diploma earned, if any. D. Grade Point Average or Class Rank and E. Major and minor field of study (if applicable).

School 1

School 2

School 3

List any foreign language(s) you know and check the boxes that describe your skill level.

ReferencesList name and telephone number of three business/work references who are not related to you and are not previous supervisor. If not applicable, list three school or personal references who are not related to you.

Reference 1

Reference 2

Reference 3

List professional, trade, business, or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)

Employment History

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below.

Educational Background (if job related)

A. List last three (3) schools attended, starting with last one. B. List number of years completed. C. Indicated degree or diploma earned, if any. D. Grade Point Average or Class Rank and E. Major and minor field of study (if applicable).

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisor. If not applicable, list three school or personal references who are not related to you.